From local audit to national learning: revisiting the case for a national colonoscopy clinical quality registry in Australia.

Colonoscopy is central to colorectal cancer prevention and early detection, yet Australia lacks a national mechanism to aggregate and benchmark colonoscopy quality data. The Colonoscopy Clinical Care Standard establishes local monitoring of key quality indicators, which can identify service-level problems, but cannot show whether variation is isolated, systemic, improving over time or concentrated in particular settings. This creates a national blind spot in one of the country's most common cancer-prevention procedures. Current arrangements remain fragmented across health services and do not support consistent national oversight. Since colonoscopy registry development was previously deprioritised in 2016, the Australian context has changed substantially: a national clinical care standard is now in place, cross-college governance of colonoscopy recertification has matured, endoscopy reporting software has improved structured data capture and broader national clinical quality registry frameworks now support more coordinated registry development. A national colonoscopy clinical quality registry could build on existing local data collection, and support coordinated national quality assurance by enabling confidential benchmarking, identifying unwarranted variation, strengthening clinical governance, and informing accreditation, training and service improvement.